Koinonia Healthcare

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

60/201542 Issued in NY

Legal business name

KOINONIA HEALTHCARE

Practice address

553 Clinton Avenue
Albany, NY 12206

Phone

(518) 689-0282

NPI assigned

Oct 3, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert John Paeglow, M.D.

Title

Director

Phone

(518) 689-0282

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Koinonia Primary Care and Psychiatric services Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan Mary Austin, M.D.

  • Psychiatry Physician
  • Troy, NY
  • NPI 1063464816
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320278400000",
    "number": "1225122054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 CLINTON AVENUE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "12206",
            "telephone_number": "518-689-0282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "553 CLINTON AVENUE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "12206",
            "telephone_number": "518-689-0282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOINONIA HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2011-11-03",
        "status": "A",
        "authorized_official_last_name": "PAEGLOW",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "518-689-0282",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "60/201542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01753680",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP GROUP",
            "identifier": "G9202",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Koinonia Primary Care and Psychiatric services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jagger Koerner
• Amelia Rae Koethen, MHC
• Maria Kofman, D.O.
• Barry Kogan
• Seth G Kohl, D.C.
• Koinonia Primary Care Inc
• Chelsea Kois, MPH, MS, CGC
• Deborah Lynn Koivula, R.N.
• Yogananda Koka
• Alice Kolasa, D.O.

• Primary Care Clinic/Center in Albany, NY
• Providers in Albany, NY by specialty
• Primary Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.